STEP FORWARD (90-120days)

Transcription

1 Effective Date: 30 Day Review Date: 90 Day Review Date: (90-120days) Contract between and - Warrenton I understand that in order to achieve the goals I have set for myself, and in order to achieve true independence and become a responsible citizen, I must have structure in my life and thereby agree to the following: Curfew School/Work Nights: 11:00pm Lights Out at 12:00pm Non School/Work Nights: 12:00pm Lights Out at unrestricted I understand that I am to answer all texts or phone calls within 10 minutes from Staff. I further understand and agree that at curfew I will be home and inside my house. At Lights Out I will be in my bed with the lights off, chores completed, PM meds taken, daily journal sent, and with no house or cell phone, computers, or any other communication devices in use. Cell Phone Unrestricted use on Weekdays Unrestricted use on Weekends I understand a cell phone is a privilege, and it may be taken away at any time for any reason. I further understand and agree that since the cell phone is company property, Management/Staff may review any and all pictures, texts, s, apps, etc. without notice. On or before my 30 Day Review Date: I will return the Program cell phone to Management/Staff that was loaned to me. If I choose to, I will purchase my own cell phone and begin a contract under my name and take full responsibility for the monthly payments.

2 Internet: I agree to use the internet responsibly. Unrestricted use on Weekdays Unrestricted use on Weekends Contract between and Warrenton Page 2 of 5 I understand a computer and having internet access in my home is a privilege, and it may be taken away at any time for any reason. I further understand and agree that since the computer is company property, Management/Staff may review any and all pictures, documents, music, search history, etc. without notice. I agree to continue to check my Step Up daily and respond to any s from my Family Support Team and Program Management/Staff. I further agree to send an for any requests for transportation for appointments and any other requests regarding the Program. Visitors I will notify Management/Staff by phone or text when I have visitors on the TLP property on weekdays and weekends. For each new visitor I will complete a Visitor Form and turn it in by 5:00pm 2 days in advance for approval or denial. See Exhibit A. Weekdays: All visitors must leave by 9:00pm Weekends: All visitors must leave by 10:00pm. Education If enrolled in school, will attend school every day, unless approved by the Management/Staff. I will turn in homework & all class assignments on time. I will study and prepare for all tests outside of school hours as necessary. I will remain on track to graduate on time. Employment I will maintain employment and communicate my schedule and any changes to Program Management/Staff. I understand and agree that if I go longer than 2 weeks without employment I will be put on Step Forward Probation and risk stepping back to Step Out. Finances I agree to maintain my Virtual Wallet Bank Account at PNC Bank and continue to use online banking. I will share any changes of my UN and PW information with Management/Staff. I agree to save at least 70% of each paycheck I receive. I understand that it is my responsible to deposit each check in the appropriate account and provide copies of paycheck stub and deposit slip showing my amounts Deposited and Balance in each account. I agree not to withdraw any money out of my Savings. I agree to work with Management/Staff to develop a budget and follow it.

3 Contract between and Warrenton Page 3 of 5 Health I agree to administer my own medications according to doctors orders. I will chart this on my Medication Administration Record (MARS). See Exhibit B. If I want to discontinue, or change my medication or dosage, I will do so only upon doctors orders I understand that I am responsible for tracking refill dates in advance of running out of my medications, and calling in for refills and picking them up. Management/Staff shall randomly perform med checks. I agree to continue to see as suggested a Primary Doctor and Dentist at Crider Health Center in Warrenton. If needed, I further agree to continue to see as suggested a Psych Doctor, Eye Doctor and a GYN (females). I will set and inform the Program of all necessary medical appointments. I will make sure to be on time and will have the doctor complete a Step Up Medical Form at each visit. I will submit this form to Management/Staff immediately upon returning home after each appointment. See Exhibit C. I agree to participate in Weekly Individual Therapy and Monthly Group Therapy. I shall remain alcohol & drug free, except for those drugs prescribed to me by my doctor. I agree to random drug tests. Food/Toiletries/Supplies I understand I will be given a $200 directly deposited into my Virtual Wallet Spend Account on the first of each month. I will shop and spend this money on groceries and toiletries for myself only, and will turn ALL receipts in to Management/Staff for all purchases within 24 hours. $150 must be used at a grocery store, and the remaining $50 can be used at any restaurant. Any unused money does not roll over. I understand that any unauthorized use of this card or failure to submit ALL receipts within 24 hours for all purchases will result in immediate revocation of the card and I will go back to the Step In procedure for groceries. I understand that all common area supplies will be provided by the Program. Examples of these items are ink cartridges, kitchen paper towels/napkins, dishwasher soap, etc. If I am in need of any Maintenance for the TLP or Supplies for the common area, I will complete a Maintenance or Supplies Request Form and submit it to Management/Staff. See Exhibit D. I further understand that all my necessities (i.e. food, shelter, utilities, etc.) will be provided by the Program for me, however any extras shall be my financial responsibility.

4 Contract between and Warrenton Page 4 of 5 Goals I agree to set 3 Goals for myself to accomplish and will complete a Written Service Agreement stating these Goals and 4 tasks showing how I plan to achieve them. See Exhibit E. I agree to include at least 1 extracurricular activity in my WSA, whether it s through school or out in the community. I understand that upon completion of these Goals, and showing respect for the House Rules & boundaries of the Program, I will be able to Graduate the Step Up Program and Step Beyond and begin a new contract allowing more independence in my own apartment! Independence/Life Skills Training I agree to use the Missouri Career Center as a resource and follow up with my assigned counselor as needed. I understand that I am responsible to set up and attend necessary appointments at the Career Center, as well as completing any paperwork or tests as needed. I agree to participate in all Program and Missouri Career Center events/trainings as scheduled. Some examples of these are, but not limited to; Big Picture Budgeting, What s In The Bank, Get Your Scrub On, The Heat Is On, Choices, Motivational Speakers - Journey, Volunteering- SeedaNeed, Resume Review, and Career Explorations. House Rules I agree to follow House Rules as posted. See Exhibit F. I understand that if I do not follow them on a consistent basis, I will be put on probation by the Program. I agree to complete a Grievance Form in order to voice my opinion on any rules, policies, or individual s actions with regards to the Program. See Exhibit G. I agree to keep my house clean and complete all my Chores and To Do s listed in my Daily Journal. I will initial next to each thing listed once they are completed. I further agree to complete a Journal Entry at the end of every day, summarizing what I did that day. (In paragraph form, using complete sentences, proper grammar, details such as times of appointments and things you did that helped you with achieving your current goals. Also list any thoughts/concerns as well as responding to any questions written to you by Step Up Management/Staff.

5 Contract between and Warrenton Page 5 of 5 I agree to strive to learn and practice the life skills taught & boundaries of the Program. At anytime if I refuse to comply with Management/Staff requests or Program Rules and Regulations, I will be put on probation by the Program in review of placement. Acknowledge of Receipt: /Resident Name Date /Caseworker Date Cathy Pritchett/Step Up TLP Management Date